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Patel D, Abdi S, Carmichael J, Balaskas K, Blandford A. What are the experiences of teleophthalmology in optometric referral pathways? A qualitative interview study with patients and clinicians. BMJ Open 2024; 14:e078161. [PMID: 38803257 PMCID: PMC11129051 DOI: 10.1136/bmjopen-2023-078161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 01/17/2024] [Indexed: 05/29/2024] Open
Abstract
OBJECTIVE Implementing teleophthalmology into the optometric referral pathway may ease the current pressures on hospital eye services caused by over-referrals from some optometrists. This study aimed to understand the practical implications of implementing teleophthalmology by analysing lived experiences and perceptions of teleophthalmology in the optometric referral pathway for suspected retinal conditions. DESIGN Qualitative in-depth interview study SETTING: Fourteen primary care optometry practices and four secondary care hospital eye services from four NHS Foundation Trusts across the UK. PARTICIPANTS We interviewed 41 participants: patients (17), optometrists (18), and ophthalmologists (6) who were involved in the HERMES study. Through thematic analysis, we collated and present their experiences of implementing teleophthalmology. RESULTS All participants interviewed were positive towards teleophthalmology as it could enable efficiencies in the referral pathway and improve feedback and communication between patients and healthcare professionals. Concerns included setup costs for optometrists and anxieties from patients about not seeing an ophthalmologist face to face. However, reducing unnecessary visits and increasing the availability of resources and capacity were seen as significant benefits. CONCLUSIONS Overall, we report positive experiences of implementing teleophthalmology into the optometric referral pathway for suspected retinal conditions. Successful implementation will require appropriate investment to set up and integrate new technology and remunerate services, and continued evaluation to ensure timely feedback to patients and between healthcare professionals is received. TRIAL REGISTRATION NUMBER ISRCTN18106677.
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Affiliation(s)
- Dilisha Patel
- UCL Interaction Centre, University College London, London, UK
| | - Sarah Abdi
- UCL Interaction Centre, University College London, London, UK
| | - Josie Carmichael
- UCL Interaction Centre, University College London, London, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - Ann Blandford
- UCL Interaction Centre, University College London, London, UK
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Sah S, Liu R, Lai H, Agrawal M, Jain P, Agashe P, Gupta A, Madhan P, Chauhan R, Chourasiya K, Bansod S, Suman, Singh G, Sule A, Singh J, Puah M, Boon J, Rojas-Carabali W, Sen P, Lee B, Sobrin L, Sen A, Agrawal R. Improving Access to Eye Care in Rural Communities: PocDoc's Web-Based Visual Acuity Screening Tool. Telemed J E Health 2024; 30:763-770. [PMID: 37707995 DOI: 10.1089/tmj.2023.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023] Open
Abstract
Objective: Visual acuity (VA) testing is crucial for early intervention in cases of visual impairment, especially in rural health care. This study aimed to determine the potential of a web-based VA test (PocDoc) in addressing the unique health care needs of rural areas through the comparison in its effectiveness against the conventional VA test in identifying visual impairment among an Indian rural population. Methods: Prospective comparative study conducted in December 2022 at a tertiary referral eye care center in central India. We evaluated all patients with the PocDoc VA tests using three device types, and the conventional VA test. Bland-Altman plot (BAP) compared PocDoc and conventional VA tests. Fisher's exact tests evaluated associations between categorical parameters. Kruskal-Wallis tests followed by post hoc Dunn's tests identified association between categorical parameters and numerical parameters. Results: We evaluated 428 patients (792 measurements of VA) with mean age 36.7 (±23.3) years. PocDoc resulted in slightly worse VA scores (mean logMAR: 0.345) than conventional (mean logMAR: 0.315). Correlation coefficient between the conventional and PocDoc logMAR VA values was rho = 0.845 and rho2 = 0.7133 (p = 6.617 × 10-215; adjusted p = 2.205 × 10-214). Most data points fell within the interchangeable range of ±0.32 on BAP. Difference between the two methods increased with higher logMAR values, indicating poorer agreement for worse VA scores. Conclusions: Identifying and addressing the unique health care needs of rural populations is critical, including access to appropriate and effective VA testing methods. Validating and improving VA testing methods can ensure early intervention and improve the quality of life for individuals with visual impairment.
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Affiliation(s)
- Shreya Sah
- University of New South Wales (UNSW) Medicine, Sydney, New South Wales, Australia
| | - Renee Liu
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - HaoXing Lai
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mahek Agrawal
- St Joseph's Institute International School, Singapore, Singapore
| | | | | | | | | | | | | | | | - Suman
- Sadguru Netra Chikatsalya, Chitrakoot, India
| | | | - Ashita Sule
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Marilyn Puah
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Joewee Boon
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - William Rojas-Carabali
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Pradnya Sen
- Sadguru Netra Chikatsalya, Chitrakoot, India
| | - Bernett Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lucia Sobrin
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
| | - Alok Sen
- Sadguru Netra Chikatsalya, Chitrakoot, India
| | - Rupesh Agrawal
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Duke NUS Medical School, Singapore, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, United Kingdom
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Zloto O, Paiusco V, Murta F. How to assess blepharoptosis via telemedicine: method and its reliability. Int Ophthalmol 2024; 44:106. [PMID: 38386214 DOI: 10.1007/s10792-024-02926-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/17/2023] [Indexed: 02/23/2024]
Abstract
PURPOSE To report the method to assess belpahroptosis and its reliability of adult ptosis using video consultation. METHODS This is a retrospective, comparative, case series. The surgical waiting list for ptosis surgery between 8/2020 and 1/2021 was checked and only cases listed for surgery via video consultation assessment, without any previous face-to-face consultation, were included. The following data were collected for patients who underwent video consultation before surgery: Demographic data, level of experience of clinician, levator function, Cogan's twitch sign, fatigability test, eye motility, presence of lagophthalmos, clinical history to rule out Myasthenia Gravis, other myopathies or Horner syndrome, whether the surgery was performed or canceled, reason for cancellation, date of surgery, type of procedure and surgeon experience. RESULTS A total of 176 patients underwent ptosis surgery. From those, 45 patients (25.6%) had only video assessment prior to surgery, 36 patients (80%) eventually underwent ptosis surgery. Surgery was canceled in 20% of the cases: in 2 cases (4.44%) due to misdiagnosis of ptosis during video consultation, confirmed on the day of surgery during pre-surgical face-to-face assessment; the other 7 cases (15.55%) belpharoptosis was confirmed on face-to-face examination but the surgery was canceled due to other reasons. The diagnosis of ptosis assessment via video consultation was corrected in 43 cases (95%) (p_value = 0.156, chi_ square). The accuracy of ptosis diagnosis was 13 out of 15 (86.7%) by fellow assessments and 30 out of 30 (100%) by consultant assessments (p_value = 0.041, chi_ square). In most of the cases ptosis assessment in video consultation included: rough judgment of levator function, eye motility and checking signs of lagophthalmos. CONCLUSIONS Video consultation is an efficient and reliable way to assess patients with ptosis, with 95% of reliability. Although a thorough ptosis assessment is advised, there was no difference between the accuracy of diagnosis on those who did not have the full suggested assessment.
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Affiliation(s)
- Ofira Zloto
- Adnexal Service, Moorfields Eye Hospital, London, EC1V 2PD, England, UK.
| | | | - Fabiola Murta
- Adnexal Service, Moorfields Eye Hospital, London, EC1V 2PD, England, UK
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Veeramani P, Pilar Martin-Gutierrez M, Agorogiannis E, Hamilton R, Griggs T, Nicholson L, Heng LZ. Efficacy and Safety outcomes of a novel model to assess new medical retina referrals in a high-volume medical retina virtual clinic. Eye (Lond) 2024; 38:168-172. [PMID: 37491441 PMCID: PMC10764806 DOI: 10.1038/s41433-023-02653-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/12/2023] [Accepted: 06/21/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Ophthalmology outpatient attendances have significantly increased recently with rising pressure from backlogs arising from the pandemic. Medical retina digital surveillance clinics for stable follow-up appointments are well established. We present a model for assessing new referrals and evaluating clinical outcomes and long-term sustainability in a complex high-volume medical retina service. METHODS Suitable routine new patient referrals were identified from electronic referrals and referred to this new pathway. Structured history, visual acuities, and intraocular pressures were recorded, and widefield colour fundus and optical coherence tomography imaging were performed at a imaging hub for asynchronous consultant-led review. RESULTS 1458 patients were invited to attend over four months, with a 13.2% did-not-attend (DNA) rate. Common diagnoses included stable diabetic retinopathy (19.9%), early age-related macular degeneration (6.7%), central serous retinopathy (8.8%), and retinal vein occlusion (6.3%). 7 patients (0.05%) required urgent same-day review. 61 (5.0%) required urgent face-to-face (F2F) assessment within two weeks. A total of 727 (59.0%) were either discharged or remained in the virtual pathway following their first visit. CONCLUSION This study encourages the use of a digital model that efficiently assesses suitable newly referred medical retina patients in both complex and local eye unit settings. This decreased the need for F2F clinics and resources. Further patient satisfaction surveys for digital services are currently being evaluated to guide long-term sustainability of this model.
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Affiliation(s)
- P Veeramani
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | - E Agorogiannis
- Manchester Royal Eye Hospital Manchester, Manchester, UK
| | - R Hamilton
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - T Griggs
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - L Nicholson
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | - L Z Heng
- Moorfields Eye Hospital NHS Foundation Trust, London, UK.
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Betzler BK, Chen H, Cheng CY, Lee CS, Ning G, Song SJ, Lee AY, Kawasaki R, van Wijngaarden P, Grzybowski A, He M, Li D, Ran Ran A, Ting DSW, Teo K, Ruamviboonsuk P, Sivaprasad S, Chaudhary V, Tadayoni R, Wang X, Cheung CY, Zheng Y, Wang YX, Tham YC, Wong TY. Large language models and their impact in ophthalmology. Lancet Digit Health 2023; 5:e917-e924. [PMID: 38000875 PMCID: PMC11003328 DOI: 10.1016/s2589-7500(23)00201-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/28/2023] [Accepted: 09/21/2023] [Indexed: 11/26/2023]
Abstract
The advent of generative artificial intelligence and large language models has ushered in transformative applications within medicine. Specifically in ophthalmology, large language models offer unique opportunities to revolutionise digital eye care, address clinical workflow inefficiencies, and enhance patient experiences across diverse global eye care landscapes. Yet alongside these prospects lie tangible and ethical challenges, encompassing data privacy, security, and the intricacies of embedding large language models into clinical routines. This Viewpoint highlights the promising applications of large language models in ophthalmology, while weighing up the practical and ethical barriers towards their real-world implementation. This Viewpoint seeks to stimulate broader discourse on the potential of large language models in ophthalmology and to galvanise both clinicians and researchers into tackling the prevailing challenges and optimising the benefits of large language models while curtailing the associated risks.
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Affiliation(s)
| | - Haichao Chen
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Ching-Yu Cheng
- Centre for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Cecilia S Lee
- University of Washington School of Medicine, Department of Ophthalmology, Seattle, WA, USA
| | - Guochen Ning
- Department of Biomedical Engineering, School of Medicine, Tsinghua University, Beijing, China
| | - Su Jeong Song
- Department of Ophthalmology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Aaron Y Lee
- University of Washington School of Medicine, Department of Ophthalmology, Seattle, WA, USA
| | - Ryo Kawasaki
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan; Artificial Intelligence Center for Medical Research and Application, Osaka University Hospital, Osaka, Japan
| | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Melbourne, VA, Australia; Ophthalmology, University of Melbourne Department of Surgery, East Melbourne, Melbourne, VA, Australia
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, Poznan, Poland
| | - Mingguang He
- Hong Kong Polytechnic University, Hong Kong Special Administrative Region, China
| | - Dawei Li
- College of Future Technology, Peking University, Beijing, China
| | - An Ran Ran
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Daniel Shu Wei Ting
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Kelvin Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore
| | | | - Sobha Sivaprasad
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital, London, UK
| | - Varun Chaudhary
- Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ramin Tadayoni
- Université Paris Cité, AP-HP, Lariboisière, Saint Louis, and Rothschild Foundation Hospitals, Paris, France
| | - Xiaofei Wang
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Yingfeng Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Guangzhou Regenerative Medicine and Health Guangdong Laboratory, Guangzhou, China
| | - Ya Xing Wang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yih Chung Tham
- Centre for Innovation and Precision Eye Health, National University of Singapore, Singapore; Department of Ophthalmology, National University of Singapore, Singapore; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore; Ophthalmology and Visual Science Academic Clinical Program, Duke-NUS Medical School, Singapore.
| | - Tien Yin Wong
- Tsinghua Medicine, Tsinghua University, Beijing, China; Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
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Lin AC, Kalaw FGP, Schönbach EM, Song D, Koretz Z, Walker E, Breazzano MP, Scott NL, Borooah S, Ferreyra H, Spencer DB, Goldbaum MH, Nudleman ED, Freeman WR, Toomey CB. The Sensitivity of Ultra-Widefield Fundus Photography Versus Scleral Depressed Examination for Detection of Retinal Horseshoe Tears. Am J Ophthalmol 2023; 255:155-160. [PMID: 37468086 DOI: 10.1016/j.ajo.2023.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Ultra-widefield (UWF) imaging is commonly used in ophthalmology in tandem with scleral depressed examinations (SDE) to evaluate peripheral retinal disease. Because of the increased reliance on this technology in tele-ophthalmology, it is critical to evaluate its efficacy for detecting the peripheral retina when performed in isolation. Therefore, we sought to evaluate UWF imaging sensitivity in detecting retinal horseshoe tears (HSTs). STUDY DESIGN Retrospective clinical validity and reliability study. METHODS A single-institutional retrospective analysis was performed on patients at the Shiley Eye Institute, University of California, San Diego. Patients with HSTs seen on SDE who underwent treatment with laser were included in the study. A total of 140 patients with HSTs in the right and/or left eyes met the inclusion criteria. Those with concomitant ruptured globes, retinal detachments, and vitreous hemorrhages were excluded. A total of 123 patients with 135 HSTs were included in the final analysis. The primary outcome was the number of HSTs detected by UWF imaging. A secondary outcome was HST location. Sensitivity was measured with respect to HST location, and statistical significance was calculated by Fisher exact testing. RESULTS A total of 69 (51.1%) HSTs were visualized on UWF images and 66 (48.9%) were not visualized. The sensitivity of UWF imaging in capturing HSTs was 7 of 41 (17.1%), 8 of 25 (32.0%), 7 of 14 (50.0%), and 47 of 55 (85.5%) for the superior, inferior, nasal, and temporal quadrants, respectively. Sensitivities between HST visibility and location were statistically significant (P < .001). CONCLUSIONS Nearly half of HSTs were missed by UWF imaging. This study demonstrates that UWF imaging alone is not sufficiently sensitive to exclude the presence of HSTs.
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Affiliation(s)
- Andrew C Lin
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Fritz Gerald P Kalaw
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA; Division of Ophthalmology Informatics and Data Science (F.G.P.K.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Etienne M Schönbach
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Delu Song
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Zachary Koretz
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Evan Walker
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Mark P Breazzano
- Retina-Vitreous Surgeons of Central New York (M.P.B.), Liverpool, New York, USA; Department of Ophthalmology & Visual Sciences (M.P.B.), SUNY Upstate Medical University, Syracuse, New York, USA
| | - Nathan L Scott
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Shyamanga Borooah
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Henry Ferreyra
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Doran B Spencer
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Michael H Goldbaum
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Eric D Nudleman
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - William R Freeman
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA
| | - Christopher B Toomey
- From the Shiley Eye Institute (A.C.L., F.G.P.K., E.M.S., D.S., Z.K., E.W., N.L.S., S.B., H.F., D.B.S., M.H.G., E.D.N., W.R.F., C.B.T.), Viterbi Family Department of Ophthalmology at University of California, San Diego, La Jolla, California, USA; Glycobiology Research and Training Center (C.B.T.), University of California, San Diego, La Jolla, California, USA..
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Wong KA, Ang BCH, Gunasekeran DV, Husain R, Boon J, Vikneson K, Tan ZPQ, Tan GSW, Wong TY, Agrawal R. Remote Perimetry in a Virtual Reality Metaverse Environment for Out-of-Hospital Functional Eye Screening Compared Against the Gold Standard Humphrey Visual Fields Perimeter: Proof-of-Concept Pilot Study. J Med Internet Res 2023; 25:e45044. [PMID: 37856179 PMCID: PMC10623222 DOI: 10.2196/45044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 04/01/2023] [Accepted: 05/31/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND The growing global burden of visual impairment necessitates better population eye screening for early detection of eye diseases. However, accessibility to testing is often limited and centralized at in-hospital settings. Furthermore, many eye screening programs were disrupted by the COVID-19 pandemic, presenting an urgent need for out-of-hospital solutions. OBJECTIVE This study investigates the performance of a novel remote perimetry application designed in a virtual reality metaverse environment to enable functional testing in community-based and primary care settings. METHODS This was a prospective observational study investigating the performance of a novel remote perimetry solution in comparison with the gold standard Humphrey visual field (HVF) perimeter. Subjects received a comprehensive ophthalmologic assessment, HVF perimetry, and remote perimetry testing. The primary outcome measure was the agreement in the classification of overall perimetry result normality by the HVF (Swedish interactive threshold algorithm-fast) and testing with the novel algorithm. Secondary outcome measures included concordance of individual testing points and perimetry topographic maps. RESULTS We recruited 10 subjects with an average age of 59.6 (range 28-81) years. Of these, 7 (70%) were male and 3 (30%) were female. The agreement in the classification of overall perimetry results was high (9/10, 90%). The pointwise concordance in the automated classification of individual test points was 83.3% (8.2%; range 75%-100%). In addition, there was good perimetry topographic concordance with the HVF in all subjects. CONCLUSIONS Remote perimetry in a metaverse environment had good concordance with gold standard perimetry using the HVF and could potentially avail functional eye screening in out-of-hospital settings.
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Affiliation(s)
- Kang-An Wong
- National University of Singapore, Singapore, Singapore
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Bryan Chin Hou Ang
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Dinesh Visva Gunasekeran
- National University of Singapore, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Raffles Medical Group, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
| | - Rahat Husain
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Joewee Boon
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Krishna Vikneson
- School of Medicine, University of New South Wales, Sydney, Australia
| | - Zyna Pei Qi Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
| | - Gavin Siew Wei Tan
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Center, Singapore General Hospital, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore, Singapore
- Eye-ACP, Duke-NUS Medical School, Singapore, Singapore
- Singapore National Eye Center, Singapore General Hospital, Singapore, Singapore
- Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, Singapore
- Singapore Eye Research Institute, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Salvetat ML, Musa M, Pellegrini F, Salati C, Spadea L, Zeppieri M. Considerations of COVID-19 in Ophthalmology. Microorganisms 2023; 11:2220. [PMID: 37764064 PMCID: PMC10538084 DOI: 10.3390/microorganisms11092220] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
Since its emergence in early 2020, the SARS-CoV-2 infection has had a significant impact on the entire eye care system. Ophthalmologists have been categorized as a high-risk group for contracting the virus due to the belief that the eye may be a site of inoculation and transmission of the SARS-CoV-2 infection. As a result, clinical ophthalmologists, optometrists, and eyecare professionals have had to familiarize themselves with the ocular manifestations of COVID-19, as well as its treatments and vaccines. The implementation of measures to prevent the transmission of the virus, such as restrictions, lockdowns, telemedicine, and artificial intelligence (AI), have led to substantial and potentially irreversible changes in routine clinical practice, education, and research. This has resulted in the emergence of a new mode of managing patients in a routine clinical setting. This brief review aims to provide an overview of various aspects of COVID-19 in ophthalmology, including the ocular manifestations related to the disease, the modes of transmission of SARS-CoV-2 infection, precautions taken in ophthalmic practice to prevent the spread of the virus, drugs, and vaccines used in the treatment of COVID-19, the impact of the pandemic on patients, clinicians, and the eye care system as a whole, and the future of ophthalmology conditioned by this global pandemic experience.
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Affiliation(s)
- Maria Letizia Salvetat
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Mutali Musa
- Department of Optometry, University of Benin, Benin City 300238, Edo State, Nigeria
| | - Francesco Pellegrini
- Department of Ophthalmology, Azienda Sanitaria Friuli Occidentale, 33170 Pordenone, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, “Sapienza” University of Rome, 00142 Rome, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, 33100 Udine, Italy
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9
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Nagino K, Okumura Y, Yamaguchi M, Sung J, Nagao M, Fujio K, Akasaki Y, Huang T, Hirosawa K, Iwagami M, Midorikawa-Inomata A, Fujimoto K, Eguchi A, Okajima Y, Kakisu K, Tei Y, Yamaguchi T, Tomida D, Fukui M, Yagi-Yaguchi Y, Hori Y, Shimazaki J, Nojiri S, Morooka Y, Yee A, Miura M, Ohno M, Inomata T. Diagnostic Ability of a Smartphone App for Dry Eye Disease: Protocol for a Multicenter, Open-Label, Prospective, and Cross-sectional Study. JMIR Res Protoc 2023; 12:e45218. [PMID: 36912872 PMCID: PMC10131757 DOI: 10.2196/45218] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Dry eye disease (DED) is one of the most common ocular surface diseases. Numerous patients with DED remain undiagnosed and inadequately treated, experiencing various subjective symptoms and a decrease in quality of life and work productivity. A mobile health smartphone app, namely, the DEA01, has been developed as a noninvasive, noncontact, and remote screening device, in the context of an ongoing paradigm shift in the health care system, to facilitate a diagnosis of DED. OBJECTIVE This study aimed to evaluate the capabilities of the DEA01 smartphone app to facilitate a DED diagnosis. METHODS In this multicenter, open-label, prospective, and cross-sectional study, the test method will involve using the DEA01 smartphone app to collect and evaluate DED symptoms, based on the Japanese version of the Ocular Surface Disease Index (J-OSDI), and to measure the maximum blink interval (MBI). The standard method will then involve a paper-based J-OSDI evaluation of subjective symptoms of DED and tear film breakup time (TFBUT) measurement in an in-person encounter. We will allocate 220 patients to DED and non-DED groups, based on the standard method. The primary outcome will be the sensitivity and specificity of the DED diagnosis according to the test method. Secondary outcomes will be the validity and reliability of the test method. The concordance rate, positive and negative predictive values, and the likelihood ratio between the test and standard methods will be assessed. The area under the curve of the test method will be evaluated using a receiver operating characteristic curve. The internal consistency of the app-based J-OSDI and the correlation between the app-based J-OSDI and paper-based J-OSDI will be assessed. A DED diagnosis cutoff value for the app-based MBI will be determined using a receiver operating characteristic curve. The app-based MBI will be assessed to determine a correlation between a slit lamp-based MBI and TFBUT. Adverse events and DEA01 failure data will be collected. Operability and usability will be assessed using a 5-point Likert scale questionnaire. RESULTS Patient enrollment will start in February 2023 and end in July 2023. The findings will be analyzed in August 2023, and the results will be reported from March 2024 onward. CONCLUSIONS This study may have implications in identifying a noninvasive, noncontact route to facilitate a diagnosis of DED. The DEA01 may enable a comprehensive diagnostic evaluation within a telemedicine setting and facilitate early intervention for undiagnosed patients with DED confronting health care access barriers. TRIAL REGISTRATION Japan Registry of Clinical Trials jRCTs032220524; https://jrct.niph.go.jp/latest-detail/jRCTs032220524. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/45218.
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Affiliation(s)
- Ken Nagino
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuichi Okumura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masahiro Yamaguchi
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jaemyoung Sung
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Masashi Nagao
- Department of Orthopedics, Juntendo University Faculty of Medicine, Tokyo, Japan.,Medical Technology Innovation Center, Juntendo University, Tokyo, Japan.,Graduate School of Health and Sports Science, Juntendo University, Tokyo, Japan
| | - Kenta Fujio
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yasutsugu Akasaki
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tianxiang Huang
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kunihiko Hirosawa
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masao Iwagami
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akie Midorikawa-Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Keiichi Fujimoto
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsuko Eguchi
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yukinobu Okajima
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
| | - Koji Kakisu
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuto Tei
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
| | - Takefumi Yamaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Daisuke Tomida
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Masaki Fukui
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Yukari Yagi-Yaguchi
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Yuichi Hori
- Department of Ophthalmology, Toho University Omori Medical Center, Tokyo, Japan
| | - Jun Shimazaki
- Department of Ophthalmology, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Yuki Morooka
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Alan Yee
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Maria Miura
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mizu Ohno
- Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takenori Inomata
- Department of Hospital Administration, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Ophthalmology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Digital Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.,AI Incubation Farm, Juntendo University Graduate School of Medicine, Tokyo, Japan
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10
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INOMATA TAKENORI, SUNG JAEMYOUNG, YEE ALAN, MURAKAMI AKIRA, OKUMURA YUICHI, NAGINO KEN, FUJIO KENTA, AKASAKI YASUTSUGU, MIDORIKAWA-INOMATA AKIE, EGUCHI ATSUKO, FUJIMOTO KEIICHI, HUANG TIANXIANG, MOROOKA YUKI, MIURA MARIA, SHOKIROVA HURRAMHON, HIROSAWA KUNIHIKO, OHNO MIZU, KOBAYASHI HIROYUKI. P4 Medicine for Heterogeneity of Dry Eye: A Mobile Health-based Digital Cohort Study. JUNTENDO IJI ZASSHI = JUNTENDO MEDICAL JOURNAL 2023; 69:2-13. [PMID: 38854846 PMCID: PMC11153075 DOI: 10.14789/jmj.jmj22-0032-r] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 10/11/2022] [Indexed: 06/11/2024]
Abstract
During the 5th Science, Technology, and Innovation Basic Plan, the Japanese government proposed a novel societal concept -Society 5.0- that promoted a healthcare system characterized by its capability to provide unintrusive, predictive, longitudinal care through the integration of cyber and physical space. The role of Society 5.0 in managing our quality of vision will become more important in the modern digitalized and aging society, both of which are known risk factors for developing dry eye. Dry eye is the most common ocular surface disease encountered in Japan with symptoms including increased dryness, eye discomfort, and decreased visual acuity. Owing to its complexity, implementation of P4 (predictive, preventive, personalized, participatory) medicine in managing dry eye requires a comprehensive understanding of its pathology, as well as a strategy to visualize and stratify its risk factors. Using DryEyeRhythm®, a mobile health (mHealth) smartphone software (app), we established a route to collect holistic medical big data on dry eye, such as the subjective symptoms and lifestyle data for each individual. The studies to date aided in determining the risk factors for severe dry eye, the association between major depressive disorder and dry eye exacerbation, eye drop treatment adherence, app-based stratification algorithms based on symptomology, blink detection biosensoring as a dry eye-related digital phenotype, and effectiveness of app-based dry eye diagnosis support compared to traditional methods. These results contribute to elucidating disease pathophysiology and promoting preventive and effective measures to counteract dry eye through mHealth.
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Affiliation(s)
- TAKENORI INOMATA
- Corresponding author: Takenori Inomata, Juntendo University Graduate School of Medicine, Department of Ophthalmology, 2-1-1 Hongo, Bunkyo-ku, Tokyo. 113-8431, Japan, TEL: +81-3-5802-1228 FAX: +81-3-5689-0394 E-mail:
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11
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Ricur G, Reyes J, Alfonso E, Marino RG. Surfing the COVID-19 Tsunami with Teleophthalmology: the Advent of New Models of Eye Care. CURRENT OPHTHALMOLOGY REPORTS 2023; 11:1-12. [PMID: 36743397 PMCID: PMC9883823 DOI: 10.1007/s40135-023-00308-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/30/2023]
Abstract
Purpose of Review In this article, we reviewed the impact resulting from the COVID-19 pandemic on the traditional model of care in ophthalmology. Recent Findings Though virtual eye care has been present for more than 20 years, the COVID-19 pandemic has established a precedent to seriously consider its role in the evolving paradigm of vision and eye care. New hybrid models of care have enhanced or replaced traditional synchronous and asynchronous visits. The increased use of smart phoneography and mobile applications enhanced the remote examination of patients. Use of e-learning became a mainstream tool to continue accessing education and training. Summary Teleophthalmology has demonstrated its value for screening, examining, diagnosing, monitoring treatment, and increasing access to education. However, much of the progress made following the COVID-19 pandemic is at risk of being lost as society pushes to reestablish normalcy. Further studies during the new norm are required to prove a more permanent role for virtual eye care.
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Affiliation(s)
- Giselle Ricur
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Joshua Reyes
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Eduardo Alfonso
- Bascom Palmer Eye Institute, University of Miami, 900 NW 17Th St., Miami, FL 33136 USA
| | - Raul Guillermo Marino
- Facultad de Ciencias Exactas Y Naturales, Universidad Nacional de Cuyo, Mendoza, Argentina
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12
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Cheng D, Babij R, Cabrera D, Yuan M, Port A, Mckenney AS, Zhu J, Van Tassel S, Imperato-McGinley J, Sun G. Effective Low-Cost Ophthalmological Screening With a Novel iPhone Fundus Camera at Community Centers. Cureus 2022; 14:e28121. [PMID: 35990564 PMCID: PMC9389029 DOI: 10.7759/cureus.28121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Ophthalmologic care is inaccessible to many people due to a variety of factors, including the availability of providers, cost of equipment for ophthalmologic care, and transportation to clinics and appointments. Because many causes of blindness are both highly prevalent and preventable once identified, it is essential to address gaps in care for underserved populations. We developed a novel 3D-printed mobile retinal camera. In this study, we organized recurring student-run screening events around New York City that took place in community centers and churches, at which we utilized our device to take retinal images. Our screening events reached a diverse population of New Yorkers, disproportionately those with lower household income, many of whom had not had recent eye exams. To validate the device for use in telehealth ophthalmologic visits, we transmitted the images to a remote ophthalmologist for evaluation and compared the result with an on-site attending physician’s dilated eye exam. The subjective assessment indicated that 97% of images captured with the mobile retinal camera were acceptable for telehealth analysis. Remote image assessment by achieved 92% sensitivity and 83% specificity in detecting optic disc cupping, compared to the gold-standard on-site dilated eye exam. In addition, the device was portable, affordable, and able to be used by those with relatively little ophthalmologic training. We have demonstrated the utility of this affordable mobile retinal camera for telehealth ophthalmologic evaluation during community screening events that reached an underserved population to detect disease and connect with long-term care.
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13
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Abstract
PURPOSE OF REVIEW The current article reviews enhancements to the delivery of glaucoma care that developed in response to the coronavirus disease 19 (COVID-19) pandemic and are likely to persist beyond its resolution. RECENT FINDINGS Literature from the review period (2020-2021) includes reports highlighting contributions of the ophthalmology community to global health during the pandemic. Glaucoma practices worldwide have instituted more robust infection control measures to mitigate severe acute respiratory syndrome coronavirus 2 transmission in the outpatient setting, and many of these modifications will endure in the post-COVID era. Operational adjustments have led to the provision of more efficient glaucoma care. A hybrid care model involving technician-based diagnostic testing and subsequent virtual consultation with a glaucoma specialist has evolved as a useful adjunct to traditional face-to-face encounters with patients. SUMMARY Glaucoma specialists, patients, and staff have adapted to a 'new normal' of glaucoma care delivery during the COVID-19 pandemic. Although innovation has propelled several improvements to glaucoma care during this global health crisis, significant barriers to more widespread implementation of teleglaucoma still exist. Whether, and in what capacity, the pandemic has permanently altered glaucoma practice patterns remains to be seen.
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Affiliation(s)
- Kateki Vinod
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai and New York Eye and Ear Infirmary of Mount Sinai, New York, New York USA
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14
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Low R, Lee JM, Lai SS, Rousselot A, Agarwal M, Agrawal R. Eye Care During the COVID-19 Pandemic: A Report on Patients' Perceptions and Experiences, an Asian Perspective. Ophthalmol Ther 2022; 11:403-419. [PMID: 34936062 PMCID: PMC8692826 DOI: 10.1007/s40123-021-00444-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/01/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION To elucidate the perceptions on eye care of patients affected by the disruption of outpatient and surgical ophthalmological services during the COVID-19 pandemic. METHODS A cross-sectional questionnaire-based survey was conducted during the reopening of outpatient services at two tertiary eye care centres in Singapore and North India. Consecutive patients were recruited from general and specialist eye clinics in June 2020. RESULTS A total of 326 patients were recruited, 200 patients from Singapore and 126 patients from New Delhi, India. The most common eye conditions were diabetic retinopathy and uveitis or ocular inflammatory conditions in the Indian centre, whereas the most common in the Singaporean centre were cataract in the pre- or postoperative stage and glaucoma. For patients from the Indian centre, 61.9% felt that COVID-19 had negatively impacted their eye disease, 58.7% were more distressed by their eye disease, 70.8% could not access appropriate eye care, 66.6% were afraid of contracting COVID-19 in the clinic, and 61.9% were accepting of teleconsultations. For patients from the Singaporean centre, 13.5% felt that COVID-19 had negatively impacted their eye disease, 19.5% were more distressed by their eye disease, 21.5% could not access appropriate eye care, 35% were afraid of contracting COVID-19 in the clinic, and only 31% were accepting of teleconsultations. CONCLUSION Patients from India appear to have been more negatively affected by the pandemic compared to patients from Singapore. This study highlights patients' perceptions of the impact of COVID-19 on eye care, perceived risks, ease of access to care and attitudes towards eye care during the pandemic. Patients' perceptions are integral in developing strategies for the best care possible. There were heterogeneous responses amongst our patients; hence, there may be a role for more individualized healthcare strategies in the future.
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Affiliation(s)
- Rebecca Low
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Jia Min Lee
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Ser Sei Lai
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore
| | - Andrés Rousselot
- Consultorios Oftalmologicos Benisek Ascarza, Buenos Aires, Argentina
| | | | - Rupesh Agrawal
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, Singapore, 308433, Singapore.
- Singapore Eye Research Institute, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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15
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Gunasekeran DV, Zheng F, Lim GYS, Chong CCY, Zhang S, Ng WY, Keel S, Xiang Y, Park KH, Park SJ, Chandra A, Wu L, Campbel JP, Lee AY, Keane PA, Denniston A, Lam DSC, Fung AT, Chan PRV, Sadda SR, Loewenstein A, Grzybowski A, Fong KCS, Wu WC, Bachmann LM, Zhang X, Yam JC, Cheung CY, Pongsachareonnont P, Ruamviboonsuk P, Raman R, Sakamoto T, Habash R, Girard M, Milea D, Ang M, Tan GSW, Schmetterer L, Cheng CY, Lamoureux E, Lin H, van Wijngaarden P, Wong TY, Ting DSW. Acceptance and Perception of Artificial Intelligence Usability in Eye Care (APPRAISE) for Ophthalmologists: A Multinational Perspective. Front Med (Lausanne) 2022; 9:875242. [PMID: 36314006 PMCID: PMC9612721 DOI: 10.3389/fmed.2022.875242] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many artificial intelligence (AI) studies have focused on development of AI models, novel techniques, and reporting guidelines. However, little is understood about clinicians' perspectives of AI applications in medical fields including ophthalmology, particularly in light of recent regulatory guidelines. The aim for this study was to evaluate the perspectives of ophthalmologists regarding AI in 4 major eye conditions: diabetic retinopathy (DR), glaucoma, age-related macular degeneration (AMD) and cataract. Methods This was a multi-national survey of ophthalmologists between March 1st, 2020 to February 29th, 2021 disseminated via the major global ophthalmology societies. The survey was designed based on microsystem, mesosystem and macrosystem questions, and the software as a medical device (SaMD) regulatory framework chaired by the Food and Drug Administration (FDA). Factors associated with AI adoption for ophthalmology analyzed with multivariable logistic regression random forest machine learning. Results One thousand one hundred seventy-six ophthalmologists from 70 countries participated with a response rate ranging from 78.8 to 85.8% per question. Ophthalmologists were more willing to use AI as clinical assistive tools (88.1%, n = 890/1,010) especially those with over 20 years' experience (OR 3.70, 95% CI: 1.10-12.5, p = 0.035), as compared to clinical decision support tools (78.8%, n = 796/1,010) or diagnostic tools (64.5%, n = 651). A majority of Ophthalmologists felt that AI is most relevant to DR (78.2%), followed by glaucoma (70.7%), AMD (66.8%), and cataract (51.4%) detection. Many participants were confident their roles will not be replaced (68.2%, n = 632/927), and felt COVID-19 catalyzed willingness to adopt AI (80.9%, n = 750/927). Common barriers to implementation include medical liability from errors (72.5%, n = 672/927) whereas enablers include improving access (94.5%, n = 876/927). Machine learning modeling predicted acceptance from participant demographics with moderate to high accuracy, and area under the receiver operating curves of 0.63-0.83. Conclusion Ophthalmologists are receptive to adopting AI as assistive tools for DR, glaucoma, and AMD. Furthermore, ML is a useful method that can be applied to evaluate predictive factors on clinical qualitative questionnaires. This study outlines actionable insights for future research and facilitation interventions to drive adoption and operationalization of AI tools for Ophthalmology.
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Affiliation(s)
- Dinesh V Gunasekeran
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Feihui Zheng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Gilbert Y S Lim
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Crystal C Y Chong
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Shihao Zhang
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Wei Yan Ng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore
| | - Stuart Keel
- Department of Ophthalmology, University of Melbourne, Melbourne, VIC, Australia
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Ki Ho Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Jun Park
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Aman Chandra
- Department of Ophthalmology, Southend University Hospital, Southend-on-Sea, United Kingdom
| | - Lihteh Wu
- Asociados de Macula, Vitreo y Retina de Costa Rica, San José, Costa Rica
| | - J Peter Campbel
- Casey Eye Institute, Oregon Health and Science, Portland, OR, United States
| | - Aaron Y Lee
- Department of Ophthalmology, University of Washington, Seattle, WA, United States
| | | | - Alastair Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Ophthalmology, University College London (UCL), London, United Kingdom
| | - Dennis S C Lam
- International Eye Research Institute of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China.,C-MER International Eye Research Center of the Chinese University of Hong Kong (Shenzhen), Shenzhen, China
| | - Adrian T Fung
- Specialty of Clinical Ophthalmology and Eye Health, Faculty of Medicine and Health, Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.,Department of Ophthalmology, Faculty of Medicine, Health and Human Sciences, Macquarie University Hospital, Sydney, NSW, Australia
| | - Paul R V Chan
- Department of Ophthalmology, University of Illinois College of Medicine, Chicago, IL, United States
| | - SriniVas R Sadda
- Department of Ophthalmology, Doheny Eye Institute, Los Angeles, CA, United States
| | - Anat Loewenstein
- Department of Ophthalmology, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Andrzej Grzybowski
- Department of Ophthalmology, University of Warmia and Mazury, Olsztyn, Poland.,Institute for Research in Ophthalmology, Ponzan, Poland
| | | | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Xiulan Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | - Jason C Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong SAR, China
| | - Carol Y Cheung
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong (CUHK), Hong Kong, Hong Kong SAR, China
| | - Pear Pongsachareonnont
- Vitreoretinal Research Unit, Department of Ophthalmology, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Paisan Ruamviboonsuk
- Department of Ophthalmology, College of Medicine, Rangsit University, Rajavithi Hospital, Bangkok, Thailand
| | - Rajiv Raman
- Vitreo-Retinal Department, Sankara Nethralaya, Chennai, India
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University, Kagoshima, Japan
| | - Ranya Habash
- Bascom Palmar Eye Institute, Miami, FL, United States
| | - Michael Girard
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Dan Milea
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,Copenhagen University Hospital, Copenhagen, Denmark
| | - Marcus Ang
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Gavin S W Tan
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Leopold Schmetterer
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center (ZOC), Sun Yat-sen University, Guangzhou, China
| | | | - Tien Y Wong
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Tsinghua Medicine, Tsinghua University, Beijing, China
| | - Daniel S W Ting
- Singapore Eye Research Institute (SERI), Singapore National Eye Center (SNEC), Singapore, Singapore.,School of Medicine, National University of Singapore (NUS), Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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16
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Zheng S, Choo J, Chen J, Joshi S, Sun Z. The barriers to global eye care equity and the role of digital innovations. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100021. [PMID: 37846323 PMCID: PMC10577845 DOI: 10.1016/j.aopr.2021.100021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 11/05/2021] [Accepted: 12/18/2021] [Indexed: 10/18/2023]
Affiliation(s)
- Sifan Zheng
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Justin Choo
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Jessica Chen
- Imperial College School of Medicine, London, United Kingdom
| | - Sarala Joshi
- Imperial College School of Medicine, London, United Kingdom
| | - Zhaohui Sun
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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17
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Kortuem FC, Ziemssen F, Kortuem KU, Kortuem C. The Role and Views of Ophthalmologists During the COVID-19 Pandemic. Clin Ophthalmol 2021; 15:3947-3956. [PMID: 34616139 PMCID: PMC8488052 DOI: 10.2147/opth.s327745] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/24/2021] [Indexed: 12/26/2022] Open
Abstract
Purpose The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic forced ophthalmologists to adjust their working conditions to ensure patient and staff safety, while still providing effective and timely treatment. This international survey among ophthalmologists was initiated to capture what actions ophthalmologists were taking and what their opinions were on the risks of infection in their workplace, the delay in treatment, the use of telemedicine and telephone for appointments, and the regional specifications and measures implemented by the respective authorities. Methods An open-source web tool was used to develop an online survey, to which ophthalmologists worldwide were invited via e-mail using international mailing lists (Media Mice, Singapore; Texere Publishing Inc, USA; CGO Gerling) and incentivized using a lottery. The physicians provided their level of agreement relating to the offered statements and gave free answers to the questions regarding the actions taken (conducted November 5th 2020 to December 20th 2020). Results After 91,000 invitations, responses were collected from 1122 ophthalmologists. Despite the use of large international mailing lists, mainly doctors from Europe participated. Half of the participants expressed great concern about possible SARS-CoV-2 infection in their patients. A significant number of younger ophthalmologists (≤50 years: 76.9%, n = 313; >50 years: 69.6%, n = 181) feared the delays that COVID-19 could cause to treatment. Reductions in patient numbers were broadly observed, with more ophthalmologists of younger age reporting greater declines. Nearly all ophthalmologists indicated that they provided disinfectant and the majority also used masks and questionnaires for screening. For 60.3% (n = 412) of ophthalmologists, telephone calls reduced the risk of ‘no-shows’; 71.6% (n = 497) disagreed that telemedical evaluation is possible without slit lamp findings and fundus photos; and 57.0% of participants felt content with the governmental measures during the COVID-19 pandemic. Conclusion The COVID-19 pandemic has significantly influenced the work of ophthalmologists. Based on the limited response rate, certain statements were only possible to evaluate for the European Union: with a noticeable reduction in patient numbers, delay in treatment was a major worry. Measures to protect and reassure patients should be undertaken, especially regarding those with vision-threatening diseases requiring treatment.
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Affiliation(s)
- Friederike C Kortuem
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
| | - Focke Ziemssen
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany.,Department of Ophthalmology, University Hospital Leipzig, Leipzig, Germany
| | | | - Constanze Kortuem
- University Eye Hospital, Center for Ophthalmology, University of Tübingen, Tübingen, Germany
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18
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Wherton J, Greenhalgh T, Shaw SE. Expanding Video Consultation Services at Pace and Scale in Scotland During the COVID-19 Pandemic: National Mixed Methods Case Study. J Med Internet Res 2021; 23:e31374. [PMID: 34516389 PMCID: PMC8500351 DOI: 10.2196/31374] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/20/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Background Scotland—a country of 5.5 million people—has a rugged geography with many outlying islands, creating access challenges for many citizens. The government has long sought to mitigate these through a range of measures including an ambitious technology-enabled care program. A strategy to develop a nationwide video consultation service began in 2017. Our mixed methods evaluation was commissioned in mid-2019 and extended to cover the pandemic response in 2020. Objective To draw lessons from a national evaluation of the introduction, spread, and scale-up of Scotland’s video consultation services both before and during the pandemic. Methods Data sources comprised 223 interviews (with patients, staff, technology providers, and policymakers), 60 hours of ethnographic observation (including in-person visits to remote settings), patient and staff satisfaction surveys (n=20,349), professional and public engagement questionnaires (n=5400), uptake statistics, and local and national documents. Fieldwork during the pandemic was of necessity conducted remotely. Data were analyzed thematically and theorized using the Planning and Evaluating Remote Consultation Services (PERCS) framework which considers multiple influences interacting dynamically and unfolding over time. Results By the time the pandemic hit, there had been considerable investment in material and technological infrastructure, staff training, and professional and public engagement. Scotland was thus uniquely well placed to expand its video consultation services at pace and scale. Within 4 months (March-June 2020), the number of video consultations increased from about 330 to 17,000 per week nationally. While not everything went smoothly, video was used for a much wider range of clinical problems, vastly extending the prepandemic focus on outpatient monitoring of chronic stable conditions. The technology was generally considered dependable and easy to use. In most cases (14,677/18,817, 78%), patients reported no technical problems during their postconsultation survey. Health care organizations’ general innovativeness and digital maturity had a strong bearing on their ability to introduce, routinize, and expand video consultation services. Conclusions The national-level groundwork before the pandemic allowed many services to rapidly extend the use of video consultations during the pandemic, supported by a strong strategic vision, a well-resourced quality improvement model, dependable technology, and multiple opportunities for staff to try out the video option. Scotland provides an important national case study from which other countries may learn.
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Affiliation(s)
- Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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19
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Dauletbaev N, Kuhn S, Holtz S, Waldmann S, Niekrenz L, Müller BS, Bellinghausen C, Dreher M, Rohde GGU, Vogelmeier C. Implementation and use of mHealth home telemonitoring in adults with acute COVID-19 infection: a scoping review protocol. BMJ Open 2021; 11:e053819. [PMID: 34580103 PMCID: PMC8478582 DOI: 10.1136/bmjopen-2021-053819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION mHealth refers to digital technologies that, via smartphones, mobile apps and specialised digital sensors, yield real-time assessments of patient's health status. In the context of the COVID-19 pandemic, these technologies enable remote patient monitoring, with the benefit of timely recognition of disease progression to convalescence, deterioration or postacute sequelae. This should enable appropriate medical interventions and facilitate recovery. Various barriers, both at patient and technology levels, have been reported, hindering implementation and use of mHealth telemonitoring. As systematised and synthesised evidence in this area is lacking, we developed this protocol for a scoping review on mHealth home telemonitoring of acute COVID-19. METHODS AND ANALYSIS We compiled a search strategy following the PICO (Population, Intervention, Comparator, Outcome) and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendation for Scoping Reviews) guidelines. MEDLINE, Embase and Web of Science will be searched from 1 March 2020 to 31 August 2021. Following the title and abstract screening, we will identify, systematise and synthesise the available knowledge. Based on pilot searches, we preview three themes for descriptive evidence synthesis. The first theme relates to implementation and use of mHealth telemonitoring, including reported barriers. The second theme covers the interactions of the telemonitoring team within and between different levels of the healthcare system. The third theme addresses how this telemonitoring warrants the continuity of care, also during disease transition into deterioration or postacute sequelae. ETHICS AND DISSEMINATION The studied evidence is in the public domain, therefore, no specific ethics approval is required. Evidence dissemination will be via peer-reviewed publications, conference presentations and reports to the policy makers.
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Affiliation(s)
- Nurlan Dauletbaev
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
- Department of Pediatrics, McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada
| | - Sebastian Kuhn
- Department of Digital Medicine, Bielefeld University Faculty of Medicine, Bielefeld, Germany
| | - Svea Holtz
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Susanne Waldmann
- Central Medical Library, Philipps-Universitat Marburg, Marburg, Hessen, Germany
| | - Lukas Niekrenz
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Beate S Müller
- Institute of General Practice, Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Michael Dreher
- Department of Pneumology and Intensive Care Medicine, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Gernot G U Rohde
- Department of Respiratory Medicine, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany
| | - Claus Vogelmeier
- Department of Internal, Respiratory and Critical Care Medicine, Philipps-Universitat Marburg, Marburg, Hessen, Germany
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20
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Tan TE, Chodosh J, McLeod SD, Parke DW, Yeh S, Wong TY, Ting DSW. Global Trends in Ophthalmic Practices in Response to COVID-19. Ophthalmology 2021; 128:1505-1515. [PMID: 34412877 PMCID: PMC8367739 DOI: 10.1016/j.ophtha.2021.07.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 02/04/2023] Open
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21
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Teo CL, Chee ML, Koh KH, Tseng RMWW, Majithia S, Thakur S, Gunasekeran DV, Nusinovici S, Sabanayagam C, Wong TY, Tham YC, Cheng CY. COVID-19 awareness, knowledge and perception towards digital health in an urban multi-ethnic Asian population. Sci Rep 2021; 11:10795. [PMID: 34031469 PMCID: PMC8144201 DOI: 10.1038/s41598-021-90098-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 04/29/2021] [Indexed: 12/24/2022] Open
Abstract
This study aimed to determine COVID-19-related awareness, knowledge, impact and preparedness among elderly Asians; and to evaluate their acceptance towards digital health services amidst the pandemic. 523 participants (177 Malays, 171 Indians, 175 Chinese) were recruited and underwent standardised phone interview during Singapore’s lockdown period (07 April till 01 June 2020). Multivariable logistic regression models were performed to evaluate the associations between demographic, socio-economic, lifestyle, and systemic factors, with COVID-19 awareness, knowledge, preparedness, well-being and digital health service acceptance. The average perception score on the seriousness of COVID-19 was 7.6 ± 2.4 (out of 10). 75.5% of participants were aware that COVID-19 carriers can be asymptomatic. Nearly all (≥ 90%) were aware of major prevention methods for COVID-19 (i.e. wearing of mask, social distancing). 66.2% felt prepared for the pandemic, and 86.8% felt confident with government’s handling and measures. 78.4% felt their daily routine was impacted. 98.1% reported no prior experience in using digital health services, but 52.2% felt these services would be helpful to reduce non-essential contact. 77.8% were uncomfortable with artificial intelligence software interpreting their medical results. In multivariable analyses, Chinese participants felt less prepared, and more likely felt impacted by COVID-19. Older and lower income participants were less likely to use digital health services. In conclusion, we observed a high level of awareness and knowledge on COVID-19. However, acceptance towards digital health service was low. These findings are valuable for examining the effectiveness of COVID-19 communication in Singapore, and the remaining gaps in digital health adoption among elderly.
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Affiliation(s)
- Cong Ling Teo
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Miao Li Chee
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Kai Hui Koh
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Rachel Marjorie Wei Wen Tseng
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Shivani Majithia
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Sahil Thakur
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Dinesh Visva Gunasekeran
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Simon Nusinovici
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore
| | - Charumathi Sabanayagam
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore.,Duke-NUS Medical School, Singapore, Singapore.,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore. .,Duke-NUS Medical School, Singapore, Singapore.
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, The Academia, 20 College Road, Discovery Tower Level 6, Singapore, 169856, Singapore. .,Duke-NUS Medical School, Singapore, Singapore. .,Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
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22
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Tseng RMWW, Gunasekeran DV, Tan SSH, Rim TH, Lum E, Tan GSW, Wong TY, Tham YC. Considerations for Artificial Intelligence Real-World Implementation in Ophthalmology: Providers' and Patients' Perspectives. Asia Pac J Ophthalmol (Phila) 2021; 10:299-306. [PMID: 34383721 DOI: 10.1097/apo.0000000000000400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ABSTRACT Artificial Intelligence (AI), in particular deep learning, has made waves in the health care industry, with several prominent examples shown in ophthalmology. Despite the burgeoning reports on the development of new AI algorithms for detection and management of various eye diseases, few have reached the stage of regulatory approval for real-world implementation. To better enable real-world translation of AI systems, it is important to understand the demands, needs, and concerns of both health care professionals and patients, as providers and recipients of clinical care are impacted by these solutions. This review outlines the advantages and concerns of incorporating AI in ophthalmology care delivery, from both the providers' and patients' perspectives, and the key enablers for seamless transition to real-world implementation.
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Affiliation(s)
| | - Dinesh Visva Gunasekeran
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore
| | | | - Tyler Hyungtaek Rim
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Gavin S W Tan
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Tien Yin Wong
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
| | - Yih-Chung Tham
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
- Duke-NUS Medical School, Singapore
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23
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INOMATA TAKENORI, SUNG JAEMYOUNG, NAKAMURA MASAHIRO, IWAGAMI MASAO, OKUMURA YUICHI, FUJIO KENTA, AKASAKI YASUTSUGU, FUJIMOTO KEIICHI, YANAGAWA AI, MIDORIKAWA-INOMATA AKIE, NAGINO KEN, EGUCHI ATSUKO, SHOKIROVA HURRRAMHON, ZHU JUN, MIURA MARIA, KUWAHARA MIZU, HIROSAWA KUNIHIKO, HUANG TIANXING, MOROOKA YUKI, MURAKAMI AKIRA. Cross-hierarchical Integrative Research Network for Heterogenetic Eye Disease Toward P4 Medicine: A Narrative Review. JUNTENDO MEDICAL JOURNAL 2021. [DOI: 10.14789/jmj.jmj21-0023-r] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- TAKENORI INOMATA
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - JAEMYOUNG SUNG
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - MASAHIRO NAKAMURA
- Department of Digital Medicine, Juntendo University Graduate School of Medicine
| | - MASAO IWAGAMI
- Department of Health Services Research, Faculty of Medicine, University of Tsukuba
| | - YUICHI OKUMURA
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - KENTA FUJIO
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - YASUTSUGU AKASAKI
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - KEIICHI FUJIMOTO
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - AI YANAGAWA
- Department of Digital Medicine, Juntendo University Graduate School of Medicine
| | | | - KEN NAGINO
- Department of Hospital Administration, Juntendo University Graduate School of Medicine
| | - ATSUKO EGUCHI
- Department of Hospital Administration, Juntendo University Graduate School of Medicine
| | | | - JUN ZHU
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - MARIA MIURA
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - MIZU KUWAHARA
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - KUNIHIKO HIROSAWA
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - TIANXING HUANG
- Department of Ophthalmology, Juntendo University Graduate School of Medicine
| | - YUKI MOROOKA
- Department of Digital Medicine, Juntendo University Graduate School of Medicine
| | - AKIRA MURAKAMI
- Department of Digital Medicine, Juntendo University Graduate School of Medicine
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